Novel Double Bronchial Balloon Techniques Were Successfully Employed in Prone Thoracoscopic Esophagectomy：One Lung Ventilation Strategies for the Tracheal Bronchus and Bilateral Thoracoscopy

Abstract

Background：In airway management during prone thoracoscopic esophagectomy, we routinely em-ploy a single lumen spiral tube and a bronchial blocker for one lung ventilation. The placement of the bronchial blocker improves tracheal and bronchial mobility during peribronchial lymph node dissection. We experienced two cases requiring careful preoperative consideration for one lung ventilation strategies. Case presentation：In case 1, contralateral paraaortic lymph node dissection was required for cura-tive resection. A Y-shaped double-balloon bronchial blocker（EZ-blocker TM ）was intubated into the trachea to occlude either right or left main bronchus ad libitum, resulting in preferable management of bilateral thoracoscopic surgery in prone position. In case 2, preoperative CT revealed a right tracheal bronchus above the carina. We decided to em-ploy two bronchial blockers following preoperative anesthetic conference. One was placed in the right tracheal bronchus as usual, and the other was placed outside the tracheal tube to occlude right bronchus intermedius. A guidewire was employed to selectively introduce the blockers to the right tracheal bronchus. Conclusions：We experienced cases requiring careful preoperative preparation for one lung ventilation in prone thoracoscopic esophagectomy. Novel double bronchial balloon techniques were successfully employed for occlusion of main bronchus and/or tracheal bronchus.